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• W2024478126 abstract "Purpose: To update the use of intensity modulated radiation therapy in the definitive treatment of head and neck cancer utilizing the SMART (Simultaneous Modulated Accelerated Radiation Therapy) boost technique. Dosimetry, toxicity, initial response and efficacy are analyzed. Materials and Methods: From January 1996 to August 2000, 50 evaluable patients were treated definitively for head and neck carcinomas with the SMART boost technique. Using the NOMOS PEACOCK intensity modulated radiation therapy system, primary and secondary targets were treated simultaneously at different fraction sizes. The primary targets included palpable and radiographic disease and were treated at 2.4 Gy fractions to a total dose of 60 Gy. Areas at risk for microscopic disease were defined as secondary targets and treated at 2.0 Gy fractions to a total dose of 50 Gy. A single anterior field was used to treat the lower neck nodes. Treatment was completed in 25 fractions delivered over 5 weeks. Patients were evaluated for acute toxicity using RTOG criteria, dosimetric parameters, time to complete treatment, initial response, locoregional control, and distant metastases. All patients had at least 6 months of follow-up. The median follow-up time was 22 months. Eleven patients received chemotherapy. Twenty-eight patients had stage IV, 7 had stage III, 7 had stage II and 5 patients had stage I disease. Recurrent disease was treated in 2 patients and one patient had an unknown primary. Results: Acute toxicity: Fifteen patients (30%) required feeding tubes. Eleven patients (22%) required IV hydration. RTOG grade 3 mucositis was seen in 20 patients (40.0%). RTOG grade 3 or 4 pharyngitis was seen in 10 patients (20%). Grade 1 or 2 xerostomia was seen in 36 patients (72%). Thirty-six patients (72%) completed treatment in less than 40 days, 9 patients (18%) in 40 to 49 days, and 5 patients (10%) in 50 or more days. Dosimetry: The mean dose to the primary and secondary targets were 63.9 Gy and 54.7 Gy respectively. The mean dose to the spinal cord was 13.6Gy, brainstem 11.5Gy, mandible 29.1Gy, ipsilateral parotid 24.7, and contralateral parotid was 20.9Gy. Initial response and relapse rates: Complete responses were seen at the primary site of disease in 46 patients (92%) while 4 patients (8%) had partial responses. Nine patients (18%) had local-regional recurrences and seven patients (14%) developed distant metastatic disease. Six patients initially had complete responses but subsequently failed in the head and neck region. Conclusion: The SMART boost technique offers the opportunity to treat both primary and secondary targets simultaneously with different fractionation schemes. The accelerated treatment regimen provides excellent local control with diminished dose to the parotid glands. The majority of patients completed the treatment in under 40 days despite increased acute toxicity." @default.
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• W2024478126 date "2001-11-01" @default.
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• W2024478126 title "Accelerated fractionation for head and neck cancer using the smart (simultaneous modulated accelerated radiation therapy) boost technique" @default.
• W2024478126 doi "https://doi.org/10.1016/s0360-3016(01)02149-6" @default.
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